Notice Of Motion And Order - Illinois Workers' Compensation Commission
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1
2ILLINOIS WORKERS’ COMPENSATION COMMISSION
NOTICE OF MOTION AND ORDER
A
. You must attach the motion to this notice. If the motion is not attached, this form may not be processed.
TTENTION
Upon filing of a motion before a Commissioner on review, the moving party is responsible for payment for preparation of the transcript.
Case # _____ WC ___________
______________________________________
Employee/Petitioner
v.
______________________________________
Employer/Respondent
TO:
AM
On _____________________ , at _______________ AM/PM , or as soon thereafter as possible, I shall appear
before the Honorable __________________________________ , or any arbitrator or commissioner appearing in
his or her place at ______________________________ , Illinois, and present the attached motion for:
Change of venue
Fees under Section 16
Reinstatement of case
___
___
___
(#3072)
(#1600)
(#3074)
Consolidation of cases
Fees under Section 16a
Request for hearing
___
(#3071)
___
___
(#1645)
(#R33)
(list case#)
Hearing under Sect.19(b)
Withdrawal of attorney
___
___
(#1902)
(#3073)
Penalties under Sect. 19(k)
Other (explain)
___
___
(#1911)
Dismissal of attorney
___
(#3052)
_________________________________
Penalties under Sect. 19(l)
___
(#1912)
Dismissal of review
___
(#3085)
_____________________________________
_____________________________________
Petitioner ____
Respondent ____
Signature
Street address
_____________________________________
_____________________________________
1
Attorney’s name and IC code # (please print)
City, State, Zip code
_____________________________________
_____________________________________
Name of law firm, if applicable
Telephone number
E-mail address
O
RDER
The motion is set for hearing on ___________________________________
_____________________________________
_____________________________________
Signature of arbitrator or commissioner
Date
O
RDER
The motion is
___ Granted
___ Withdrawn
___ Continued to
________________
___ Denied
___ Dismissed
___ Set for trial (date certain) on
________________
_____________________________________
_____________________________________
Signature of arbitrator or commissioner
Date
IC4 4/11 100 W. Randolph Street #8-200 Chicago, IL 60601 312/814-6611
Toll-free line 866/352-3033
Web site:
Downstate offices: Collinsville 618/346-3450
Peoria 309/671-3019
Rockford 815/987-7292
Springfield 217/785-7084
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